Rural Health Safety Net In Peril

Suggesting that the rural health safety net could “crumble” without some sort of federal intervention, Maggie Elehwany, the National Rural Health Association’s (NRHA’s) vice president of government affairs, briefed U.S. Senate staffers this week on the crisis facing her constituents.

Medicaid expansion and continued cuts in Medicare were among several of the challenges Elehwany described in her briefing, which was billed as “Rural Health 101” Tuesday on Capitol Hill. The briefing was sponsored by the Senate Rural Health Caucus, which includes co-chairs Sen. Pat Roberts (R-Kan.) and Al Franken (D-Minn.).

Elehwany also spoke on the significant role rural providers play for the older, sicker, and poorer populations they serve.

“Sixty-two million patients rely on rural providers,” Elehwany said. “These providers are facing unprecedented challenges from Washington, from challenges in Medicaid expansion, continued cuts in Medicare, and continued threats of additional Medicare cuts.”

Elehwany urged the Senate to protect access to care for these vulnerable populations, and to save the 283 rural hospitals that are on the brink of closure. Already 53 rural hospitals have closed since 2010. Without congressional intervention, layoffs, wage cuts, economic loss, reduced services, and more such shutdowns are expected to occur in more rural communities across America.

“If Congress doesn’t act to stop the bleeding and prevent further closures of rural hospitals, 700,000 patients would lose timely access to care,” Elehwany cautioned. “Patients and local economies in your state will suffer.”

Among the questions from Senate staffers, two in particular illuminate the state of affairs of America’s rural health system: one addressed the need to examine new means by which care can be provided to rural populations, and the other cited an upcoming U.S. Supreme Court decision, specifically the King v. Burwell case. It is estimated that about 6.4 million people could lose subsidies in 34 states that use the federal health care marketplace, depending on the outcome of that ruling.

In answer to a staffer’s question about a different model of care for the rural population, Elehwany said that NRHA has been studying the issue of “future rural health care models” for years.

“Because rural communities are extremely different from one another, several models are being examined,” she explained. “Our goal is to advance models that ensure quality and appropriate access to care for rural communities. Emergency care access is certainly part of the equation.”

Elehwany suggested that a community needs assessment should determine what primary care makes sense for each rural community.

“It would be great to give rural providers the flexibility to take on the health challenges of a rural community (for example, diabetes) and really try to improve population health, which ultimately will bend the cost curb on spending,” Elehwany told staffers. “If a rural provider could share in the cost savings, it would be a great win for the patients, the provider, and the taxpayer.”

With the Supreme Court decision expected at the end of June or the first week in July, one staffer wanted to know how the outcome could affect rural communities.

“More rural Americans are eligible for federal tax credits than their urban counterparts,” she added, referring to a report issued by the Kaiser Family Foundation.

Elehwany’s appearance at the briefing came a day after the Mayor of Belhaven, N.C. concluded a two-week walk from his rural town to Washington, D.C. to call attention to the plight of rural hospitals, one of which in his town closed in 2014. Last year, O’Neal made the same walk – at that time to protest the death of 48-year-old Portia Gibbs. According to the organization’s news release, Gibbs suffered a heart attack and died after waiting – one hour, in the back of ambulance, in a high school parking lot – for a medical helicopter to arrive. She could have been at Belhaven Hospital in less than 30 minutes had it not closed just six days earlier.